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Malaria is declining but transmission persists in many rural areas and among rural dwellers and isolated populations. In remote communities, conventional health services and education are limited. Mobilising and educating these populations require new approaches as many people are illiterate and do not attend village meetings. This work assesses the feasibility of a drama project as a community engagement strategy to curb scourge malaria. The article, however, highlights how the creative arts and a participatory approach can contribute meaningfully to enhanced community awareness about the major public health risk of malaria.


Malaria remains a leading cause of morbidity and mortality world-wide, especially in pregnant women and children, and particularly in tropical Africa, where at least 90% of the malaria deaths occur. Yet, malaria is a curable disease and not an inevitable burden. Effective medicines and preventive measures are available. However, these effective and relatively inexpensive interventions reach only a small proportion of the populations in need, mainly because of insufficient financial resources.

During the last decade, new medicines and approaches have been developed for malaria case management, for selective vector control and for epidemic detection and control. Malaria has become integrated into other health programmes and partnerships have been increased both internationally and nationally by the Roll Back Malaria (RBM) Initiative instigated by WHO's Director General in 1998s.

s.These developments have led to increased the global awareness of malaria, and in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) started operations. By middle of -2004, the GFATM has allocated nearly two 2 billion US dollars $ for malaria control over a five-year period. Although this remains far from covering the global needs, for the first time since the global malaria eradication campaign from 1956 to 1968, the international funding available for malaria control is making it possible to reduce the global burden. WHO is the international organization whose mission it is to define standards for the prevention, control and possible elimination of the major international disease problems.



A key project objective was to build the capacity of community-based structures to enable them engage in behaviour change communication activities in relation to malaria prevention at the community level. The aim was to:

> Increase knowledge among families and communities concerning malaria, its transmission and understanding that the mosquito is the only vector of malaria

> Promote communities’ uptake of malaria prevention methods, including the correct and consistent use of long lasting insecticidal mosquito nets, allowing indoor residual spraying in their homes, and uptake of intermittent preventive treatment by pregnant women at antenatal care services

> Increase timely healthcare seeking at health facilities or from trained community health workers for the diagnosis and treatment forthose with signs and symptoms of malaria.


Yala is a Local Government Area in Cross River State, Nigeria. Its headquarters are in the town of Okpoma in the east of the area at 6°35′35″N 8°38′01″E.

It has an area of 1,739 km² and a population of 210,843 at the 2006 census.1. This makes Yala the second most populated LGA in Cross River State, coming after Akpabuyo. The postal code of the area is 550.2

The dominant tribes in the Area are the Yala. Major settlements in Yala LGA include Okpoma, Okuku, Yahe, Ugaga, Ijegu, Oloko, Imaje, Oke, Echumoga, Woda, Ebo, Igede Edii Nation, Itekpa, Maa, Wonye, Uchu, Osina, Mbuor, Aliforkpa, Echumofana, Wanihem, Wanikade, Wanokom, Ijiraga, Ntrigom etc. Yala is also a language spoken by some inhabitants of Yalaland.

Other major tribes in Yala Local Government Area are, Igede-Edii (Anyadaha, Anyugbe, Eminyi, Ibilla, Igbakobor and Opiriku), Itekpa, Gabu, Ukele and Yache. They speak Igede, Ukelle, and Yache language, respectively. The LGA offers a wide range of investment opportunities in agro-based industries as well as solid mineral industries.


The drama project combined Yala drama, art, music workshops and village concerts and competitions to provide health education in a fun and an engaging way. Yala local drama uses caricatures in a funny and irreverent manner and the productions did so to weave together stories and health education. The project mixed with art and drama lasted for three days.


All projects involve local stakeholders at the local and  village level. In the drama project, local leaders and community were involved in its planning and implementation.The  team first introduced the project to and sought approval and support from the local government primary health care authorities. Meetings were held in the target communities with village leaders, key opinion leaders identified by staff of the provincial health department and other prominent members to deliberate on the proposed project.

Professional drama performers were recruited to ensure a professional outing. A series of workshops were organised to train the team on the malaria messages to incorporate into the drama performance. The final main script, storyline, and key messages were approved by the local government health authorities.

In each village, the team and village leaders met with the dwellers to explaine the purpose of the project and to introduce the activities involved. Key opinion leaders in each village played an active role throughout the project development and progress.


The project  comprised a series of three-days workshops with the drama group travelling from one village to another every third day. During the workshops, villagers shared their talents and local stories, which were integrated as part of the drama performance. School children were invited to participate to sing songs about malaria in Yala and create drawings with the malaria theme. Teenagers and young people were invited to participate in the drama. On the third evening, the activities included singing competitions, songs and a quiz on malaria, followed by a 45-minute drama performance by both locals and professional drama team members. These events took place in the village square, usually near a school or temple, starting about 4pm and ending at 8pm or 9pm.


Due to the timing of the project, the study was conducted  before the rainy season. Travelling from one village to another was considerably slower and everything took longer. Performance dates were often rescheduled due to the degraded road conditions. The tidous nature of the road made it difficult for villagers to participate in the drama workshops and performance. Malaria incidence occurs throughout the year but most malaria cases are confined to the months during or directly after the rainy season; it would have been more appropriate to deliver the malaria messages before the rainy season begins. Using printed media such as leaflets and posters to raise malaria awareness, may therefore be less successful in these areas. In developing countries, folk media such as folk songs, dramas, puppet shows and dance have been used as community engagement strategies for health education and to encourage research participation 13– 15. Yala dramas, which use comedy and music to tell stories with local references and language that resonates with villagers, are popular in rural communities. In light of the need to convey messages about malaria and the  programme in a comprehensible and appropriate fashion, traditional Cambodian drama was used as a means to supplement existing text-based messaging on malaria and other efforts rolled out by the local health authorities and education system. The vVillage drama programme was a pilot project that sought to encourage people to prevent mosquito bites by using insecticide-treated nets and repellents, get early diagnosis and treatment from the malaria and to raise awareness about the risk of malaria in rural areas.



To assess if the project can be used to convey the three key messages of the project (to use insecticide-treated nets and repellents, to get early diagnosis and treatment, and to raise awareness about the risk of malaria on rural dwellers), interviewers asked the villagers about the lessons that they had learnt from the drama.

When asked about the drama, villagers faced no difficulty recapitulating the storyline, which comprised two main characters, one of whom slept under a bednet while the other slept without protection. The latter contracted malaria and went to meet the VMW, who performed a blood test to confirm the malaria diagnosis. He was given a three-days malaria medication and later recovered. The respondents felt that the team gave simple and straightforward key messages, which were easy to be understooand to the local community, including people who were illiterate.

Some villagers said that the drama would bring about behavioural changes in their daily lives. Compared with before the drama, solely relying on mosquito nets, they would now use mosquito repellents during the day. Men who go to the forest would bring mosquito nets with them and wear long-sleeved clothing.


The drama performance was described as funny and entertaining., It and made learning and understanding about malaria much more interesting compared with the conventional health education methods. Villagers, especially, enjoyed watching children dressed as mosquitoes while singing songs about malaria.


Community engagement is increasingly recognized as integral to successful and ethical health-related research .(Tindana et al., , Singh, Tracy  :2017) To maximize the efficiency of the community engagement programme, a combination of 'top-down' and 'bottom-up' approaches are needed (Atkinson et al., , Vallely, Fitzgerald :2011) Such a combination of approaches was taken to promote village drama  project. Taking 'top-down' approach, support was garnered from the provincial health department, village leaders and other respected members of the community which would then convince the local communities to participate. Taking a 'bottom-up' approach, local communities were encouraged to actively participate in the planning and execution of the three3-days events and to contribute stories and ideas to the drama performance, an approach the villagers claimed they have never experienced before.Our engagement project used drama and various music genres which appealed to both the younger and older generations.

Interviewee: “For me, I really think this is very valuable for the community.”

Interviewer: “Really, uncle? So it provides benefits for the community?”

Interviewee: “Yes, it really does. And recently people have been involved in activities, for example: blood testing and so on.”


During the focus group discussion, youths felt that they learned how to perform in public and to express their thoughts. They further requested for materials related to ways of preventing malaria so that they could spread such awareness in schools. At the end of the project, video recordings and photos of the workshops and performances in the form of DVDs were distributed to all village leaders as souvenirs. All photos and videos were taken at public places and with formal written permission from the national and provincial authorities.




Everybody needs to know about malaria; The mosquitoes they come biting;

Stay inside mosquito nets, Everybody needs to know about malaria;

Prevent mosquitoes from hunting; Stay alive, do not miss the mosquito net.



We conclude that although there were many challenges, village drama and its associated activities such as competitions and workshops is feasible as a community engagement strategy. Audience members recalled the plot of the performance and the malaria-related messages, indicating that the key messages were clear and concrete. Villagers perceived drama as entertaining and as the preferred choice of community engagement activity. Using drama is a promising way to engage communities and could be considered as part of the community engagement for malaria elimination.




Tindana PO, Singh JA, Tracy CS, et al. : Grand challenges in global health: community engagement in research in developing countries. PLoS Med. 2007;4(9):e273. 10.1371/journal.pmed.0040273


Atkinson JA, Vallely A, Fitzgerald L, : 2011)The architecture and effect of participation: a systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar J. 2011;10:225. 10.1186/1475-2875-10-225


National Institute of Statistics, Directorate General for Health, ICF International: (2015) Cambodia Demographic and Health Survey 2014. National Institute of Statistics, Directorate General for Health, and ICF International: Phnom Penh, Cambodia, and Rockville, Maryland, USA.



Mobilising communities for malaria prevention and control in Mozambique